An Objective Method to Assess and Recommend Exertion and Exercise Targets for Return to Play Post concussion

Authors

Joseph F. Clark PhD ATC, Department of Neurology and Rehabilitation Medicine, University of CincinnatiFollow
Robert E. Mangine PT MEd ATC, Department of Athletics and NovaCare Rehabilitation, University of CincinnatiFollow
Kimberly A. Hasselfeld MS, Division of Sports Medicine, Department of Orthopaedic Surgery, University of CincinnatiFollow
Violet T. Schramm, Division of Sports Medicine, Department of Orthopaedic Surgery, University of CincinnatiFollow
Angelo J. Colosimo MD, Division of Sports Medicine, Department of Orthopaedic Surgery, University of CincinnatiFollow
Aaron Kuehn-Himmler AT MS, Department of Athletics and NovaCare Rehabilitation, University of CincinnatiFollow
Gerald M. Holloway MS ATC, Department of Athletics and NovaCare Rehabilitation, University of CincinnatiFollow
Faniel Fosselman DO MBA, Division of Sports Medicine, Department of Orthopaedic Surgery, University of CincinnatiFollow
Jon Vincent, University of CincinnatiFollow
Nicole Giordano, Department of Neurology and Rehabilitation Medicine, University of CincinnatiFollow
Jon G. Divine MD MS, Division of Sports Medicine, Department of Orthopaedic Surgery, University of CincinnatiFollow

Abstract

Introduction.

Concussions are of significant concern for athletic trainers, and there is a critical need to objectively and safely allow an athlete to return to play. In sports the objective is return as safely and soon as possible. Exertion is a consideration regarding progressing an athlete back to play. The ability to exert in cardiovascular and strength and conditioning contexts are two critical steps in most return to play protocols. Being able to make objective recommendations is urgently needed, as trial and error leads to unnecessary risk of eliciting symptoms and/or causing setbacks.

Objective.

The object of this paper is to present the athletic trainer with data associated with a methodology that can be used to aid in designing a cardiovascular and strength training program post concussion. This objective measure does not rely on subjective patient reports of symptoms and utilizes a reflex based assessment method.

Description.

The transient exertion related carotid (TERC) murmur is a murmur that is heard at the carotid arteries during exercise. It normally is heard at around a heart rate of 150, but is heard at lower heart rates in patients who have sustained a concussion. Listening for the TERC murmur during a cardiovascular and strength training assessment can be used to provide information to the athletic trainer about safer target heart rates or safer lifting strategies post-concussion. We present data concerning 71 athletes (mean age 20.8 years) who were assessed for cardiovascular conditioning and body weight assessment. With 73% of the cardio assessment subjects, a TERC murmur was detected at a heart rate of 127.2 bpm (± 16 SD). For the strength assessment 42.1% had a TERC murmur.

Clinical advantages.

The clinical advantage of the TERC murmur is that it can be utilized by any athletic trainer trained to take a blood pressure. It provides objective information concerning safe target heart rates that will allow an athletic trainer to recommend appropriate exercise prescriptions. The TERC murmur assessment can also be used to help guide strength training protocols to facilitate safe return. Being able to safely recommend a means by which an athlete can recommence their training (cardiovascular and/or strength training) may accelerate return to play as well as aid in keeping the athlete happy, healthy and engaged.

Recommended Citation

Clark, Joseph F. PhD ATC; Mangine, Robert E. PT MEd ATC; Hasselfeld, Kimberly A. MS; Schramm, Violet T.; Colosimo, Angelo J. MD; Kuehn-Himmler, Aaron AT MS; Holloway, Gerald M. MS ATC; Fosselman, Faniel DO MBA; Vincent, Jon; Giordano, Nicole; and Divine, Jon G. MD MS (2021) "An Objective Method to Assess and Recommend Exertion and Exercise Targets for Return to Play Post concussion," Journal for Sports Neuroscience: Vol. 1: Iss. 1, Article 4.
Available at: https://nsuworks.nova.edu/neurosports/vol1/iss1/4